
<!DOCTYPE html>
<html>

<head>

    <meta charset="utf-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">


    <title>微信商户申请</title>
    <meta name="keywords" content="H+后台主题,后台bootstrap框架,会员中心主题,后台HTML,响应式后台">
    <meta name="description" content="H+是一个完全响应式，基于Bootstrap3最新版本开发的扁平化主题，她采用了主流的左右两栏式布局，使用了Html5+CSS3等现代技术">

    <link rel="shortcut icon" href="favicon.ico">
    <link href="{$Think.config.site.resource_url}css/bootstrap.min.css" rel="stylesheet">
    <link href="{$Think.config.site.resource_url}css/font-awesome.css?v=4.4.0" rel="stylesheet">
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    <link href="{$Think.config.site.resource_url}css/style.min.css?v=4.1.0" rel="stylesheet">
    <link href="{$Think.config.site.resource_url}css/plugins/datapicker/datepicker3.css" rel="stylesheet">
</head>

<body class="gray-bg">
<div class="wrapper wrapper-content animated fadeInRight">

    <div class="row">
        <div class="col-sm-12">
            <form action="https://www.xinnar.com" method="post" class="form-horizontal">
                <div class="ibox float-e-margins">
                    <div class="ibox-title">
                        <h5>联系信息</h5>
                    </div>
                    <div class="ibox-content">
                    
                        <div class="form-group">
                            <label class="col-sm-2 control-label">联系人姓名*</label>

                            <div class="col-sm-10">
                                <input type="text" class="form-control">
                                <span class="help-block m-b-none">请填写贵司微信支付业务联系人</span>
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label">手机号码*</label>
                            <div class="col-sm-10">
                                <input type="text" class="form-control">
                                <span class="help-block m-b-none">该号码非常重要，将接收与微信支付管理相关的重要信息。</span>
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label">常用邮箱*</label>

                            <div class="col-sm-10">
                                <input type="text" class="form-control" name="password">
                                <span class="help-block m-b-none">非常重要！用于接收微信支付的账号密码</span>
                            </div>
                        </div>
                    </div>
                </div>
                <div class="ibox float-e-margins">
                    <div class="ibox-title">
                        <h5>经营信息</h5>
                    </div>
                    <div class="ibox-content">

                        <div class="form-group">
                            <label class="col-sm-2 control-label"><h3>商户信息</h3></label>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label">商户名称*</label>

                            <div class="col-sm-10">
                                <input type="text" placeholder="商户名称" class="form-control">
                                <span class="help-block m-b-none">商户名称需与营业执照登记公司名称一致</span>
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label">注册地址*</label>

                            <div class="col-sm-10">
                                <input type="text" placeholder="注册地址" class="form-control">
                                <span class="help-block m-b-none">注册地址需与营业执照登记住所一致</span>
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label">商户简称*</label>

                            <div class="col-sm-10">
                                <input type="text" placeholder="商户简称" class="form-control">
                                <span class="help-block m-b-none">该简称将在支付完成页向买家展示，需与微信经营类目相关</span>
                            </div>
                        </div>
                        
                        <div class="form-group">
                            <label class="col-sm-2 control-label">经营类目*</label>

                            <div class="col-sm-10">
                                <div class="row">
                                    <div class="col-md-2">
                                        <select class="form-control m-b" name="account">
                                            <option>企业类型</option>
                                            <option>选项 2</option>
                                            <option>选项 3</option>
                                            <option>选项 4</option>
                                        </select>
                                    </div>
                                    <div class="col-md-3">
                                        <select class="form-control m-b" name="account2">
                                            <option>所在行业</option>
                                            <option>选项 2</option>
                                            <option>选项 3</option>
                                            <option>选项 4</option>
                                        </select>
                                    </div>
                                    <div class="col-md-4">
                                        <select class="form-control m-b" name="account3">
                                            <option>经营类目</option>
                                            <option>选项 2</option>
                                            <option>选项 3</option>
                                            <option>选项 4</option>
                                        </select>
                                    </div>
                                </div>
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label">客服电话*</label>

                            <div class="col-sm-10">
                                <input type="text"  placeholder="客服电话" class="form-control">
                                <span class="help-block m-b-none">
                                该电话将在交易记录中向买家展示，买家可借此来联系贵司客服<br>
                                请注意填写格式，座机务必填写区号（座机：0755-88880000；手机：13688880000；400电话：4008880000）<br>
                                请确保此电话畅通，我方会进行回拨确认，无法接通将导致申请被驳回
                                </span> 
                            </div>
                        </div>
                        
                         <div class="form-group">
                            <label class="col-sm-2 control-label">公司网站</label>

                            <div class="col-sm-10">
                                <input type="text"  placeholder="公司网站" class="form-control">
                                <span class="help-block m-b-none">
                                网站域名需ICP备案，若备案主体与申请主体必须相同<br>
                                </span> 
                            </div>
                        </div>
                        
                        <div class="form-group">
                            <label class="col-sm-2 control-label">补充材料</label>

                            <div class="col-sm-10">
                                <button class="btn btn-primary" type="button">上传文件</button>
                                <span class="help-block m-b-none">
                                在整个申请流程中，遇到需提供资料但无上传入口的情况，都可在此处上传。
必须为彩色图片（文档请截图后上传），最多5张，单张小于2M，格式为bmp、png、jpeg、jpg或gif<br>
                                </span> 
                            </div>
                        </div>
                        <div class="hr-line-dashed"></div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label"><h3>营业执照</h3></label>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label">营业执照注册号*</label>

                            <div class="col-sm-10">
                                <input type="text" placeholder="营业执照注册号" class="form-control">
                                <span class="help-block m-b-none">请输入18位统一社会信用代码</span>
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label">经营范围*</label>

                            <div class="col-sm-10">
                                <textarea type="text" placeholder="经营范围" class="form-control"></textarea>
                                <span class="help-block m-b-none">与企业工商营业执照上一致</span>
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label">营业期限*</label>
                            <div class="col-sm-10">
                                <input placeholder="开始日期" class="form-control layer-date" id="start">
                                <input placeholder="结束日期" class="form-control layer-date" id="end">
                                <label class="checkbox-inline">
                                    <input type="checkbox" value="option1" id="inlineCheckbox1">
                                    长期
                                </label>
                            </div>
                        </div>
                        
                        <div class="form-group">
                            <label class="col-sm-2 control-label">营业执照照片*</label>

                            <div class="col-sm-10">
                                <button class="btn btn-primary" type="button">上传文件</button>
                                <span class="help-block m-b-none">
                                需年检章齐全（当年成立公司除外）;<br>
                                必须为彩色图片且小于2M，文件格式为bmp、png、jpeg、jpg或gif
                                </span> 
                            </div>
                        </div>
                        <!--<div class="hr-line-dashed"></div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label"><h3>组织机构代码证</h3></label>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label">组织机构代码*</label>

                            <div class="col-sm-10">
                                <input type="text" placeholder="商户简称" class="form-control">
                                <span class="help-block m-b-none">请输入9位组织机构代码</span>
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label">营业期限*</label>

                            <div class="col-sm-10">
                                <input type="text" placeholder="商户简称" class="form-control">
                                <span class="help-block m-b-none">该简称将在支付完成页向买家展示，需与微信经营类目相关</span>
                            </div>
                        </div>
                        
                        <div class="form-group">
                            <label class="col-sm-2 control-label">组织机构代码证照片*</label>

                            <div class="col-sm-10">
                                <button class="btn btn-primary" type="button">上传文件</button>
                                <span class="help-block m-b-none">
                                必须为彩色图片且小于2M，文件格式为bmp、png、jpeg、jpg或gif
                                </span> 
                            </div>
                        </div>-->


                        <div class="hr-line-dashed"></div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label"><h3>企业法人/经办人</h3></label>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label">证件持有人类型*</label>

                            <div class="col-sm-10">
                                <div class="row">
                                    <div class="col-md-2">
                                        <div class="radio i-checks">
                                            <label>
                                                <input type="radio" value="option1" name="a">
                                                <i></i> 经办人
                                            </label>
                                        </div>
                                    </div>
                                    <div class="col-md-3">
                                        <div class="radio i-checks">
                                            <label>
                                                <input type="radio" value="option2" name="a">
                                                <i></i> 法人
                                            </label>
                                        </div>
                                    </div>
                                    
                                </div>
                                
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label">证件持有人姓名*</label>

                            <div class="col-sm-10">
                                <input type="text" placeholder="证件持有人姓名" class="form-control">
                                <span class="help-block m-b-none"></span>
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label">证件类型*</label>

                            <div class="col-sm-10">
                                <div class="row">
                                    <div class="col-md-2">
                                        <div class="radio i-checks">
                                            <label>
                                                <input type="radio" value="option1" name="a">
                                                <i></i> 身份证(限中国大陆居民)
                                            </label>
                                        </div>
                                    </div>
                                    <div class="col-md-3">
                                        <div class="radio i-checks">
                                            <label>
                                                <input type="radio" value="option2" name="a">
                                                <i></i> 护照(境外人士)
                                            </label>
                                        </div>
                                    </div>
                                    
                                </div>
                                
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label">身份证正面照片*</label>

                            <div class="col-sm-10">
                                <button class="btn btn-primary" type="button">上传文件</button>
                                <span class="help-block m-b-none">
                                必须为彩色图片且小于2M，文件格式为bmp、png、jpeg、jpg或gif
                                </span> 
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label">身份证反面照片*</label>

                            <div class="col-sm-10">
                                <button class="btn btn-primary" type="button">上传文件</button>
                                <span class="help-block m-b-none">
                                必须为彩色图片且小于2M，文件格式为bmp、png、jpeg、jpg或gif
                                </span> 
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label">证件有效期*</label>

                            <div class="col-sm-10">
                                <div class="input-daterange input-group" id="datepicker">

                                    <input type="text" class="input-sm form-control" name="start" value="2014-11-11"/>
                                    <span class="input-group-addon">到</span>
                                    <input type="text" class="input-sm form-control" name="end" value="2014-11-17"/>
                                </div>
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label">证件号码*</label>

                            <div class="col-sm-10">
                                <input type="text" placeholder="证件号码" class="form-control">
                                <span class="help-block m-b-none"></span>
                            </div>
                        </div>
                     </div>
                </div>

                <div class="ibox float-e-margins">
                    <div class="ibox-title">
                        <h5>结算账户</h5>
                    </div>
                    <div class="ibox-content">
                        <div class="form-group">
                            <label class="col-sm-2 control-label">账户类型*</label>

                            <div class="col-sm-10">
                                <div class="row">
                                    <div class="col-md-2">
                                        <div class="radio i-checks">
                                            <label>
                                                <input type="radio" value="option1" name="a">
                                                <i></i> 对公账户
                                            </label>
                                        </div>
                                    </div>
                                    <div class="col-md-3">
                                        <div class="radio i-checks">
                                            <label>
                                                <input type="radio" value="option2" name="a">
                                                <i></i> 法人账户
                                            </label>
                                        </div>
                                    </div>
                                    
                                </div>
                                <span class="help-block m-b-none">只有个体工商户才可以选择法人账户</span>
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label">开户银行*</label>

                            <div class="col-sm-10">
                                <input type="text" class="form-control">
                                <span class="help-block m-b-none">请填写完整的开户银行名称</span>
                            </div>
                        </div>
                        <div class="hr-line-dashed"></div>
                        <div class="form-group">
                            <label class="col-sm-2 control-label">银行账号*</label>
                            <div class="col-sm-10">
                                <input type="text" class="form-control">
                                <span class="help-block m-b-none">请填写完整的银行账号。</span>
                            </div>
                        </div>
                        
                        <div class="form-group">
                            <div class="col-sm-4 col-sm-offset-2">
                                <button class="btn btn-primary" type="submit">提交申请</button>
                            </div>
                        </div>
                    </div>
                </div>
            </form>
        </div>
    </div>
</div>


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<script>
    $(document).ready(function () {
        $(".i-checks").iCheck({checkboxClass: "icheckbox_square-green", radioClass: "iradio_square-green",})
    });
    var start = {
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        max: "2099-06-16 23:59:59",
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            end.start = datas
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        max: "2099-06-16 23:59:59",
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            start.max = datas
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    laydate(start);
    laydate(end);
</script>
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